Scintigraphic gallbladder visualization with gangrenous acalculous cholecystitis.

Hepatobiliary scintigraphy evaluates the biliary clearance of Tc-99m-labeled iminodiacetic acid agents (Tc-99m IDA) and has a high sensitivity and specificity for the diagnosis of acute cholecystitis. False-negative studies are extremely rare. We describe an apparently normal nonmorphine-augmented hepatobiliary study in gangrenous acalculous cholecystitis. Based on clinical findings, computed tomography, and ultrasound demonstration of a dilated gallbladder, a cholecystectomy was performed. Pathologic examination of the gallbladder revealed acute gangrenous cholecystitis with culture positive for Klebsiella pneumoniae.

Malakoplakia occurring in association with colon carcinoma.

Malakoplakia, characterized by histiocytes with Michaelis-Gutmann bodies, is a rare entity. It is particularly so in the gastrointestinal tract, where it has been described in association with colon cancer, with about 20 cases described worldwide. The significance of this condition lies in its potential effect upon the preoperative staging and treatment of associated colorectal cancer. Its presence may lead to preoperative clinical and radiological over staging and more extensive resection, as well as the use of neoadjuvant therapy or a decision to undertake palliative care. This condition is more common in males. We present the case of the oldest reported patient with this association. The patient was a 90-year-old female who was treated with a sigmoid resection for an obstructing sigmoid lesion. At operation, the left ureter was embedded within an inflammatory pericolic mass but was not grossly involved with tumor. The tumor was a Dukes' stage B adenocarcinoma and occurred in association with malakoplakia.